Ed's Note: In order to protect the privacy of the children profiled in this article, the identities of the clients and the location of the advocacy center have been changed.

The first thing you notice when you walk into the Children's Advocacy Center in this mid-sized Midwestern town are the teddy bears. They're lined up on wicker bookshelves and tucked into the corners of flowered couches and chairs. They seem to welcome children inside a place that is warm, cozy -- and safe.

Most of the children who walk into this center are scared. They're here because someone -- a parent, baby-sitter, daycare provider, family friend or doctor -- suspects they may be the victim of sexual abuse. The allegations, based on medical reports, children's disclosures or sexual acting-out at home or in daycare, have to be investigated by a team of people that may include social service workers, police detectives, prosecutors and a doctor.

In this child-friendly atmosphere -- where kids can play with toys, eat snacks in the kitchen, see a friendly doctor and then tell their story to an adult in a room with child-sized chairs and a doll's house -- the hope is that a child who has been hurt won't have to endure any more fear or pain.

Before this center opened, children in the area who were suspected victims of abuse often had to be interviewed over and over again by people from different social service agencies, sometimes in stark police interrogation rooms, and sometimes at school, where other children knew something was up.

"A child could be interviewed three or four times," says "Melissa Stone," the executive director of this Child and Family Advocacy Program. "Imagine how intimidating and horrible that would be. It's revictimizing children." At the center, a child has to tell a very difficult story only once, interviewed in a playroom by a trained child forensics interviewer, and videotaped through a two-way mirror. Across the hall is a bright and cheerful examining room -- a far cry from a chaotic emergency room, where many child victims are taken -- where a pediatrician who specializes in knowing the signs of sexual abuse sees the child right away. There's a playroom for kids and a kitchen where parents who are not suspects in the cases can be comforted or counseled by a staff social worker.

"The place is so comfy," says Stone, "that sometimes the kids don't want to go back home."

	Facts About Child Sexual Abuse What is child sexual abuse? Child sexual abuse is forced, tricked, or coerced sexual behavior between a young person and an adult. It may consist of nudity, disrobing, genital exposure, "peeping Tom" behavior, kissing, fondling, masturbation, oral-genital contact, child pornography, penetration with a finger, and vaginal or anal intercourse. The behavior must have a sexual intent: a baby-sitter washing a two-year-old's private parts during the course of a normal bath is not sexual abuse. Who is vulnerable? Approximately 115,000 cases of sexual abuse enter child protective services caseloads each year. Most children are abused by adults who are related to them or known to their families. With girls, from one-third to one-half of perpetrators were relatives. With boys, one-tenth of abusers were related. There has been a recent increase in the number of juveniles who have committed sexually aggressive acts against other children. In 80 to 95 percent of cases, child abuse perpetrators are male. The most vulnerable age for sexual abuse is between 7 and 13 years, although cases are documented from infancy. Girls are sexually abused three times more often than boys. Sexual abuse happens to children in all socioeconomic and education levels, and across all racial and cultural groups. Children who are left alone at home are more likely to become a victim of sexual abuse.

Across the country, there are some 300 Children's Advocacy Centers. These centers are easier not only on children, but on law enforcers. The centers began in the 1980s -- the first was a renovated Victorian cottage in Huntsville, Alabama -- after several notoriously complicated child abuse cases, such as the McMartin preschool case. In this case, allegations muddied and multiplied as more and more interviewers talked to the children, making it clear that investigations needed to be limited and coordinated in one place.

When investigations spread to many locations and interviewers, children often become increasingly insecure and scared, causing them to withdraw, or spin tales in order to please their persistent interviewers. Funded by private donations, so the staff remain neutral in any investigation, the centers have developed from safe places to interview children to centers for wider community education and training about how to recognize and prevent child abuse.

The center makes cases of child abuse easier to prosecute, says "Elizabeth Kettle," the District Attorney in this town. In most child sexual abuse cases there are no witnesses and no medical evidence; the cases come down to a child's word against an adult's, and if the child's disclosure is confused or changes, it's very tough to prosecute. Children are more likely to disclose abuse in a safe and comfortable environment, Kettle says, and their videotaped interviews are harder for defense attorneys to dismiss. Because the interviewers are trained to be neutral -- "I always pretend I have a defense attorney over my left shoulder," says "Joan Harleman," the staff interviewer -- they are less likely to ask the kinds of leading questions that attorneys can object to in court. More cases settle early, and so fewer children have to endure going to trial -- telling their story once again, in a courtroom full of strangers.

In this town, the child abuse cases are much like those anywhere in the country. The center sees about one case of suspected child abuse a day. The people who walk in the door are from families of all income and education levels. Most of the accused perpetrators are not strangers to the victims, but relatives and acquaintances: in this county, over half of alleged perpetrators are family members, a third are acquaintances such as a mother's boyfriend, one in ten are people the children trust (such as neighbors or friends' parents or grandparents), and only six percent are strangers. Forty-four percent of perpetrators are juveniles, who have been abused themselves, now acting out by molesting younger children, who in turn may make the problem snowball if the cycle isn't stopped. The victims are usually very young; in this county last year, a third were under five, and a third were six to ten years old.

But not every case that comes through the center ends up being sexual abuse: in many instances, an interview and exam reveal that the suspected abuse probably never occurred, and parents leave with some information and counseling -- and greatly eased minds. Over the course of a week at this Children's Advocacy Center, a typical variety of cases came in.

Case One

At 10:00, a married couple and their two daughters, ages two and six, come into the center. A social services worker, "Sandra Calcagno," has already briefed the staff about the case: The parents brought the six-year-old in to see the family physician because she had redness and swelling in her genital area. The physician believed the genital injuries might be consistent with sexual abuse in the older girl, and he had previously seen the younger girl for suspicious genital bleeding; under the law, he reported his findings to the department of social services. No one knows who the perpetrator might be; it could be the dad. Joan Harleman, the social worker at the center, greets the parents and leads the children to the playroom, where they sit on a giant stuffed dog and make beaded necklaces. Calcagno and the center's physician, "Kelly Rosenquist" ("Dr. Kelly"), lead the parents into a comfortable interview room.

The parents are blond, well-groomed, outdoorsy types in fleece jackets. They don't look like parents who could abuse their children, but as Dr. Kelly warned earlier, looks are deceiving. "You find sexual abuse in all kinds of families," she says. The parents are openly nervous.

"We're just swirling," says the mother.

"We've never been involved in anything like this," says the father, trying to control himself. "I don't want to blast the system. If it helps one kid, it's good, but I feel targeted."

Calcagno assures them that she doesn't have any preconceived ideas about what happened. "The doctor called with a report of a swollen clitoris, and we need to go over it." She begins the interview asking the parents what the children know about safety. "They know that no one is to touch any part that the bathing suit covers up," says the mom. Calcagno nods. They go over the family situation -- dad's an architect, mom works part-time, the family recently moved, the kids changed daycare. Then they talk about the children's medical histories, including the findings.

The father shifts uncomfortably. "I can't help but feel accused," he says. "The physician's assistant said it's sexual abuse, and in 99% of the cases, it's the male in the house. That's me."

Calcagno and Dr. Kelly assure him they're going to get to the bottom of what happened, and that the physician's assistant was talking out of line. "It could be a long list of things," says Dr. Kelly. "It could be anything from a urethal prolapse to sexual abuse. I'm just checking them off." They explain how the older daughter, "Lisa," will be interviewed and examined (the two-year-old, too young to disclose anything, will have a medical exam).

Calcagno greets Lisa, and explains that she has a special room to play in. In the interview room, with videotape rolling, the child gets settled with paper and crayons, and Calcagno establishes a rapport with her, asking questions about the pictures she's coloring and her family. She establishes the child's ability to understand whether an object is over, under, or on the side of another object (to be sure there's no confusion about what it means when a child uses those terms in a description). She then checks her answers to questions she already knows -- such as her dad's occupation -- and determines her ability to tell a story with details, such as going to Grandma's house for Christmas. Calcagno makes sure the child can distinguish between truth and a lie -- is it true that you have a brother, or false; is it true that you're smart? -- and makes a deal with her to tell the truth. She tells Lisa that her job is to make sure children are safe, and asks her if she knows what being safe means. "Don't go into people's cars," she answers, "Don't cross the street without a parent, and mom and dad don't leave us at home alone."

The red-headed child switches to playing with puppets, and Calcagno asks why she went to the doctor recently.

"Sometimes when I pee it burns," says the girl, matter-of-factly.

Calcagno then turns to the topic of private parts. She asks if the girl knows about keeping her "privates" safe. "Don't let anyone touch you there," Lisa says. Would she tell if someone did? "Yes," she says. Would you tell if mom and dad did? "Maybe." "Would you tell me?" asks Calcagno. "Maybe." The chatty red-headed girl is starting to become uncomfortable. Calcagno brings out drawings of outline of bodies, and asks Lisa to point out and tell her about different body parts, including privates. Lisa cooperates. When Calcagno asks her if anyone has ever touched her private parts, she says her mom and dad, giving her a bath. Anyone else? Lisa shakes her ponytail no. Anyone mean? No. Eventually Calcagno finds out that Lisa's privates have been itching, and she's been scratching, which hurts. When she asks how things are at home with her parents, the bright little girl sighs and replies, "Asi-asi," using the Spanish phrase for "so-so," which she's picked up at school. She openly tells Calcagno that they moved recently, and her parents fight sometimes and she's worried.

After the interview, Lisa sees Dr. Kelly, who finished her exam on the two-year-old, where everything looked normal. "I'm going to check your whole body and make sure you're healthy," she tells Lisa. She lifts her stethoscope and checks her heart. "Anyone ever touch you here?" she asks. "No," says the girl. She checks her ears and belly, and asks the same question. "Now I'm going to check your niney," she says, using the girls' word for her genitals. She covers her up with a blanket to stay private, and asks her to sit like a frog. "Ooo, that looks sore," she says. "Does that hurt?" The child nods. "Sometimes my niney gets itchy," she says. Dr. Kelly asks a few more questions, pulls the girl's pants up, and then offers her a stuffed animal. Lisa leaves the room, happy with a big stuffed dog.

Dr. Kelly confers with Calcagno. "I think what this all comes down to," she says, "Is a case of pinworms." Calcagno nods: from the girl's interview, she doesn't suspect abuse.

They meet again with the parents. "It's been delightful to see your kids," says Dr. Kelly. "They're so adorable and articulate." The parents seem to breathe easier. Dr. Kelly explains that she believes the girl has pinworms, and that both may have an unusual medical condition -- benign familial hematuria -- that could explain the bleeding. She recommends some medication, and refers them to a specialist. "I feel comfortable saying I don't suspect sexual abuse," says Dr. Kelly. The parents exchange glances and seem to instantly relax. Calcagno mentions to the parents that their child is a little stressed by their fighting and the recent move. "I think you might need to work on the fighting," she says, and offers to refer them to a counselor. She ushers them out. "I know this has been a hard day."

Case Two

This morning, Sandra Calcagno brings in a seven-year-old girl wearing worn, ill-fitting T-shirt and shorts, who was recently taken from her mother's custody because of drug charges against the mother. The most complicated cases of alleged sexual abuse are those where children are caught in a custody case or between warring parents, Calcagno says. This girl is living with a foster parent, and the mother is worried that the dad, who visits, may be sexually abusing her. The girl has been masturbating excessively, and acting out sexually with her foster sister, touching her inappropriately in the bath and pulling down her pants.

In the interview room, Calcagno teaches "Jessica" to fish for fruit loops in a bowl. She asks the preliminary questions about truth and lies, determining if she can count, and other tests. She makes a deal that if Jessica tells the truth, she'll also answer any questions she has truthfully.

"Has my mom been drinking cocaine?" the girl demands. Calcagno says she doesn't know, and asks Jessica if she's worried. Jessica tells a story about how her mom drank cocaine when a guy gave her some in her tea. "She loves tea," she says. Then she failed a drug test because she drank the tea.

When Calcagno starts asking questions about whether Jessica understands what it means to be safe, she becomes agitated, swishing the water out of the bowl. She says no one has ever touched her private parts, except her dad and her foster mother. Calcagno asks whether her dad touched her when he was taking bath, or other times. She asks how he touched her in a bath, and she says he washed her with a sponge. Jessica then blurts out how her dad broke her mom's nose, and then he got a new wife. She saw them taking off their clothes, and they told her she shouldn't have peeked.

After that, Jessica refuses to answer questions for awhile. Calcagno asks her if she pulled down her pants at home. "I wanted to show my new underwear to my foster sister," she says. She gets up from the fishing game and goes over to the doll house, where she pulls all the furniture out violently, making it a "new house." She says she feels bad living where she is now. "Everything's confusing," she tells Calcagno. "I'm getting more confused every second." She says she wants to go back to living with her mother.

Calcagno tries again, asking if anyone has ever touched her on her privates. "I told you about that," Jessica snarls. "Nobody except my mom and dad."

Whatever is wrong with this child -- and there is plenty -- she isn't going to make a disclosure about sexual abuse today, whether because she doesn't want to get her dad in trouble, she wants to go back to living with her mom, or because nothing happened. "In a lot of cases, you never know," says Calcagno, who will continue to follow the case and recommend that the girl goes into play therapy, where in several sessions of play, she may become comfortable enough to disclose or act out what's happening to her.

Case Three

A department of social services social worker, "Henry Singer," arrives with a blond five-year-old girl, with a recently-brushed ponytail and a bright green outfit, and her parents, casually dressed professionals in their late �30s. The girl woke up from a nap at daycare complaining that her private parts were hurting, and she made a statement that her eight-year-old brother did it. In an interview, the child's parents told Singer they'd asked about why her genitals were irritated, and first she said she fell, then she said a girl at school did it. "They're frustrated, because they talked to her about crying wolf, but if their son has done something, they want to know about it," says Singer.

Singer interviews the girl while she plays with colored ribbons and draws. After establishing that she knows true from false and doing other tests, he asks her about her family. "Krista" moves to the doll's house and starts playing a game where members of her family -- some made up -- move from room to room while she commands them in a sing-song voice to go here or there. Singer eventually asks Krista if anyone has ever touched her private parts. In the same dreamy voice, she tells a confused yet detailed story about a girl at her school who touched her privates over her clothes while she was walking. Then Devon touched Michael's, and Michael ran over and touched Emily, and pretty soon, according to her account, everyone was touching everyone's privates in the coatroom while she was peeking. Singer asks again if anyone ever touched her private parts. She drops her complicated story. "No, except "Alison" one time," she says. Singer asks if her eight-year-old brother ever touched her privates. "No, never in his whole life," she says, emphatically. "Four people can touch my privates: A nurse, a doctor, my mom or my dad."

After a medical exam, it turns out that the girl has an infection that is causing her to itch quite a bit. Singer suspects that she's a perfectionistic, bright kid under pressure, and she's making up stories to deflect her anxiety about itching, which causes her to masturbate more than is normal at her age. He tells the parents to take her to a doctor, check in with the daycare teacher about the other kids, and monitor her play with her brother. "Her story was too convoluted," says Singer. "And there were no red flags. I'm pretty sure there's been no touching, except maybe once by a friend at school."

Case Four

Detective "Shelley Michaels" arrives at the center with a tidy, weary-looking mother and her four energetic girls. The eight-year-old, "Amy," told her mother that her friend's grandfather had touched her private parts under her clothes. The mother immediately called the police. Now she's sitting in the kitchen with a counselor while her girls play and watch a video in the other room. Last night, the mother says, she went to the police station to see where her child would be interviewed. "It was a big concrete building, like Gotham City," she says. She was relieved to be at the advocacy center instead.

The detective asks Amy preliminary questions, identifying parts of the body, and has her tell her what happened to Snow White to see how she tells a story. The long-haired girl is serious and cooperative. Michaels asks what happened when she was playing a couple of days ago.

Amy tells a detailed story about going to the recreation center with her 5-year-old sister, the sister's friend, and the friend's Grandpa. After playing, they went upstairs to the pool and the exercise room to use the bathroom. They played on the equipment, and while Amy was on the treadmill, hidden from sight from the other girls behind a big weight machine, Grandpa stood next to her and told her to turn around and walk backwards. "He touched me where he's not supposed to," she says. "He put his hand down my shorts." The detective asks if she said anything, and the girl shakes her head no. She doesn't want to talk about it.

The detective rolls some play dough. Slowly -- like pulling teeth -- the story comes out. Michaels asks how the man touched Amy, what she was wearing, how his hand got inside her underwear, and what he did. "He put his finger up my butt," she says, ashamed. "How long did it last?" Amy can barely speak. "A while."

Amy describes how the man kissed her later, while he was learning down, out of sight, near the candy machine. A few days earlier, it comes out, he had put his hand under her undershirt and rubbed. Michaels asks her if she told her mother the first time.

"No," says Amy. And why did she tell this time? "The first time, I thought he would stop. The second time I knew he would do it again," she says. Michaels asks how it feels now that she finally told her mom. "A little bit better," says Amy.

Later, Michaels says Amy's statement is strong. She'll go back to the pool to see if there were witnesses, interview the other girls, and try to corroborate all the details -- the position of the candy machine, the weight machines, the type of car he drove. "Juries want evidence -- more than just what an 8-year-old says." If the details check out, she'll make an arrest.

Once Grandpa is arrested, the case will likely be settled out of court. If he is a previous offender, he may be put in jail. If it's the first time, it could be probation and treatment, registering for the rest of his life as a sex offender wherever he lives. "The suspect is in his sixties," says Michaels, "I'd be surprised if this is the first time it's happened."

This case is unusual, says Michaels, in that the girl told her mother right away. Usually, children feel too embarrassed, ashamed, or scared to say anything. "This mom had talked to the girls about safety, touching, and telling," says Michaels.

What's not unusual is that the alleged perpetrator was a trusted family friend. "Parents always do a good job of talking about strangers," says Michaels. "Every kid knows to keep away from strangers. But they've never been told to be afraid of Grandpa, Grandma, or a family friend. Usually it's someone who knows the kids, and befriends them."

Amy is back in the TV room, bouncing on the couch with her sisters. As the family gets ready to leave, she pauses to pick out her stuffed animal. Amy hugs a teddy bear and goes back home.

***

Advocacy Centers -- Community centers for child abuse investigations:

- National Network of Children's Advocacy Centers; 800-239-9950 or 202-639-0597; www.nncac.org

- National Children's Advocacy Center (Hunstville, AL); 205-533-0531

- Southern Regional Children's Advocacy Center; 800-747-8122 or 704-285-9588

- Midwest Regional Children's Advocacy Center; 773-363-6700 x421

- Northeast Regional Children's Advocacy Center; 800-662-4124 or 215-387-9500

- Western Regional Children's Advocacy Center; 800-582-2203 or 719-543-0380

Child Abuse Hotlines:

Child Help USA: 800-FOR A CHILD; www.childhelpusa.com

Prevent Child Abuse America: 800-835-2671; www.childabuse.org

Stop It Now: 888-PREVENT

To Report Suspected Child Sexual Abuse

- Call your local Department of Social Services